Skip to main content

Evolving Treatment in Non-muscle-Invasive Bladder Cancer

  • Chapter
  • First Online:
Urologic Oncology

Abstract

Treatment for NMIBC is evolving and depends on many factors including cancer pathology, risk stratification, and patient’s medical comorbidities, among many other aspects. Historically, NMIBC has been treated with surgical resection and intravesical BCG. More recently, many other forms of intravesical therapy including non-BCG immunotherapy, chemotherapy, gene therapy, viral therapy, and others, have been studied to treat patients with NMIBC. Primary goals of these new bladder preserving therapies include preventing disease recurrence and disease progression while improving overall survival. This chapter begins with a short introduction into the disease process and then shifts focus to the many treatment options for NMIBC. We discuss surgical management, the role for BCG and other immunotherapy, use of chemotherapy and then go into detail about the newest treatment options and their relevant clinical trials.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. SEER*Explorer Application [Internet]. [cited 2021 Jan 2]. Available from: https://seer.cancer.gov/explorer/application.html?site=71&data_type=1&graph_type=2&compareBy=stage&chk_stage_104=104&chk_stage_105=105&chk_stage_106=106&chk_stage_107=107&sex=1&race=1&age_range=1&hdn_rate_type=1&advopt_precision=1&advopt_display=2.

  2. Bladder Cancer — Cancer Stat Facts [Internet]. [cited 2021 Jane 4]. Available from: https://seer.cancer.gov/statfacts/html/urinb.html.

  3. Heney NM. Natural history of superficial bladder cancer: prognostic features and long-term disease course. Urol Clin N Am. 1992;93:249.

    Google Scholar 

  4. Cookson MS, Herr HW, Zhang ZF, Soloway S, Sogani PC, Fair WR. The treated natural history of high risk superficial bladder cancer: 15- year outcome. J Urol. 1997;158:62.

    Article  CAS  Google Scholar 

  5. Partin AW, Dmochowski RR, Louis R, Kavoussi CAP. Campbell-Walsh-Wein Urology. In: Campbell-Walsh-Wein Urology. 2020.

    Google Scholar 

  6. Epstein JI. The new World Health Organization/International Society of Urological Pathology (WHO/ISUP) classification for TA, T1 bladder tumors: is it an improvement? Crit Rev Oncol/Hematol. 2003;47:83–9.

    Google Scholar 

  7. Humphrey PA, Moch H, Cubilla AL, Ulbright TM, Reuter VE. The 2016 WHO classification of tumours of the urinary system and male genital organs—part B: prostate and bladder tumours. Eur Urol. 2016;

    Google Scholar 

  8. Droller MJ. Biological considerations in the assessment of urothelial cancer: A retrospective. Urology [Internet]. 2005 Nov [cited 2021 Jan 2];66(5 SUPPL.):66–75. Available from: https://pubmed.ncbi.nlm.nih.gov/16194710/.

  9. Wolff EM, Liang G, Jones PA. Mechanisms of disease: genetic and epigenetic alterations that drive bladder cancer [Internet]. Vol. 2, Nature Clinical Practice Urology. Nature Publishing Group; 2005 [cited 2021 Jan 2]. p. 502–10. Available from: www.nature.com/clinicalpractice/uro

  10. Olumi AF, Tsai YC, Nichols PW, Skinner DG, Cain DR, Bender LI, et al. Allelic loss of chromosome 17p distinguishes high grade from low grade transitional cell carcinomas of the bladder. Cancer Res. 1990;

    Google Scholar 

  11. Cohen MB, Carroll PR, Kerschmann R, Cohen MB, Field FG, Mayall BH. Centromeric copy number of chromosome 7 is strongly correlated with tumor grade and labeling index in human bladder cancer. Cancer Res. 1991;

    Google Scholar 

  12. Degtyar P, Neulander E, Zirkin H, Yusim I, Douvdevani A, Mermershtain W, et al. Fluorescence in situ hybridization performed on exfoliated urothelial cells in patients with transitional cell carcinoma of the bladder. Urology [Internet]. 2004 [cited 2021 Jan 2];63(2):398–401. Available from: https://pubmed.ncbi.nlm.nih.gov/14972510/

  13. Chatterjee SJ, Datar R, Youssefzadeh D, George B, Goebell PJ, Stein JP, et al. Combined effects of p53, p21, and pRb expression in the progression of bladder transitional cell carcinoma. J Clin Oncol [Internet]. 2004 [cited 2021 Jan 2];22(6):1007–13. Available from: https://pubmed.ncbi.nlm.nih.gov/14981105/

  14. EORTC risk tables: predicting recurrence and progression in stage Ta T1 bla – Evidencio [Internet]. [cited 2021 Jan 10]. Available from: https://www.evidencio.com/models/show/1025.

  15. Bladder Cancer: Non-Muscle Invasive Guideline – American Urological Association [Internet]. [cited 2021 Jan 10]. Available from: https://www.auanet.org/guidelines/bladder-cancer-non-muscle-invasive-guideline.

  16. Mariappan P, Zachou A, Grigor KM. Detrusor muscle in the first, apparently complete transurethral resection of bladder tumour specimen is a surrogate marker of resection quality, predicts risk of early recurrence, and is dependent on operator experience. Eur Urol [Internet]. 2010 May [cited 2021 Jan 2];57(5):843–9. Available from: https://pubmed.ncbi.nlm.nih.gov/19524354/.

  17. Ouzaid I, Panthier F, Hermieu JF, Xylinas E. Contemporary surgical and technical aspects of transurethral resection of bladder tumor [Internet]. Vol. 8, Translational Andrology and Urology. AME Publishing Company; 2019 [cited 2021 Jan 2]. p. 21–4. Available from: /pmc/articles/PMC6414345/?report=abstract.

    Google Scholar 

  18. Cui Y, Chen H, Liu L, Chen J, Qi L, Zu X. Comparing the efficiency and safety of bipolar and monopolar transurethral resection for non-muscle invasive bladder tumors: a systematic review and meta-analysis. J Laparoendosc Adv Surg Tech [Internet]. 2016 Mar 1 [cited 2021 Jan 2];26(3):196–202. Available from: https://pubmed.ncbi.nlm.nih.gov/26799841/

  19. Zhao C, Tang K, Yang H, Xia D, Chen Z. Bipolar versus monopolar transurethral resection of nonmuscle-invasive bladder cancer: a meta-analysis [Internet]. Vol. 30, Journal of Endourology. Mary Ann Liebert Inc.; 2016 [cited 2021 Jan 2]. p. 5–12. Available from: https://pubmed.ncbi.nlm.nih.gov/26413779/.

  20. V8–07: En bloc bladder tumor resection: back to oncologic basics | AUA University [Internet]. [cited 2021 Jan 7]. Available from: https://auau.auanet.org/content/v8-07-en-bloc-bladder-tumor-resection-back-oncologic-basics.

  21. Kramer MW, Rassweiler JJ, Klein J, Martov A, Baykov N, Lusuardi L, et al. En bloc resection of urothelium carcinoma of the bladder (EBRUC): a European multicenter study to compare safety, efficacy, and outcome of laser and electrical en bloc transurethral resection of bladder tumor. World J Urol [Internet]. 2015 Dec 1 [cited 2021 Jan 2];33(12):1937–43. Available from: https://pubmed.ncbi.nlm.nih.gov/25910478/.

  22. Chang SS, Boorjian SA, Chou R, Clark PE, Daneshmand S, Konety BR, et al. Diagnosis and treatment of non-muscle invasive bladder cancer: AUA/SUO guideline. J Urol. 2016;196:1021.

    Article  Google Scholar 

  23. Miladi M, Peyromaure M, Zerbib M, Saïghi D, Debré B. The value of a second transurethral resection in evaluating patients with bladder tumours. In: European Urology [Internet]. Elsevier; 2003 [cited 2021 Jan 2]. p. 241–5. Available from: https://pubmed.ncbi.nlm.nih.gov/12600426/.

  24. Herr HW. The value of a second transurethral resection in evaluating patients with bladder tumors. J Urol [Internet]. 1999 [cited 2021 Jan 2];162(1):74–6. Available from: https://pubmed.ncbi.nlm.nih.gov/10379743/.

  25. HERR HW. Restaging transurethral resection of high risk superficial bladder cancer improves the initial response to bacillus calmette-guerin therapy. J Urol [Internet]. 2005 Dec [cited 2021 Jan 31];174(6):2134–7. Available from: http://www.jurology.com/doi/10.1097/01.ju.0000181799.81119.fc.

  26. See WA. Can restaging transurethral resection of T1 bladder cancer select patients for immediate cystectomy? In: Herr HW, Donat SM, Dalbagni G, editors. Urologic Oncology: Seminars and Original Investigations, vol. 25. New York: Department of Urology, Memorial Sloan-Kettering Cancer Center; Elsevier; 2007. p. 276.

    Google Scholar 

  27. Fujimoto N, Harada S, Terado M, Sato H, MATSUMOTO T. Multiple biopsies of normal-looking urothelium in patients with superficial bladder cancer: Are they necessary? Int J Urol [Internet]. 2003 Dec 1 [cited 2021 Jan 2];10(12):631–5. Available from: https://doi.org/10.1046/j.1442-2042.2003.00724.x

  28. Tran K, Severn M. Blue light cystoscopy in patients with suspected non-muscle invasive bladder carcinoma: a review of clinical utility. 2017 [cited 2021 Jan 2];1–15. Available from: https://pubmed.ncbi.nlm.nih.gov/28825777/.

  29. Jocham D, Witjes F, Wagner S, Zeylemaker B, Van Moorselaar J, Grimm MO, et al. Improved detection and treatment of bladder cancer using hexaminolevulinate imaging: a prospective, phase III multicenter study. J Urol. 2005;174(3):862–6.

    Article  Google Scholar 

  30. Filbeck T, Pichlmeier U, Knuechel R, Wieland WF, Rößler W. Senkung des rezidivrisikos oberflächlicher harnblasenkarzinome mittels 5-aminolävulinsäure-induzierter fluoreszenzdiagnostik: Resultate einer 5-jahres-studie. Urol - Ausgabe A [Internet]. 2003 Oct 25 [cited 2021 Jan 2];42(10):1366–73. Available from: https://link-springer-com.eresources.mssm.edu/article/10.1007/s00120-003-0355-y.

  31. Xiong Y, Li J, Ma S, Ge J, Zhou L, Li D, et al. A meta-analysis of narrow band imaging for the diagnosis and therapeutic outcome of non-muscle invasive bladder cancer. PLoS One. 2017;12:e0170819.

    Article  Google Scholar 

  32. Naito S, Algaba F, Babjuk M, Bryan RT, Sun YH, Valiquette L, et al. The Clinical Research Office of the Endourological Society (CROES) Multicentre Randomised Trial of Narrow Band Imaging–Assisted Transurethral Resection of Bladder Tumour (TURBT) versus conventional white light imaging–assisted turbt in primary non–muscle-invasive bladder cancer patients: trial protocol and 1-year results. Eur Urol. 2016;70(3):506–15.

    Article  Google Scholar 

  33. Tschirdewahn S, Harke NN, Hirner L, Stagge E, Hadaschik B, Eisenhardt A. Narrow-band imaging assisted cystoscopy in the follow-up of patients with transitional cell carcinoma of the bladder: a randomized study in comparison with white light cystoscopy. World J Urol [Internet]. 2020 Jun 1 [cited 2021 Jan 2];38(6):1509–15. Available from: https://pubmed.ncbi.nlm.nih.gov/31471739/.

  34. Pruthi RS, Baldwin N, Bhalani V, Wallen EM. Conservative Management of Low Risk Superficial Bladder Tumors. J Urol [Internet]. 2008 Jan [cited 2021 Jan 2];179(1):87–90. Available from: http://www.jurology.com/doi/10.1016/j.juro.2007.08.171.

  35. Schrag D, Hsieh LJ, Rabbani F, Bach PB, Herr H, Begg CB. Adherence to surveillance among patients with superficial bladder cancer. JNCI J Natl Cancer Inst [Internet]. 2003 Apr 16 [cited 2021 Jan 3];95(8):588–97. Available from: https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/95.8.588.

  36. Mori K, Miura N, Babjuk M, Karakiewicz PI, Mostafaei H, Laukhtina E, et al. Low compliance to guidelines in nonmuscle-invasive bladder carcinoma: a systematic review. Vol. 38, Urologic oncology: seminars and original investigations. Elsevier Inc.; 2020. p. 774–82.

    Google Scholar 

  37. van Osch FHM, Nekeman D, Aaronson NK, Billingham LJ, James ND, Cheng KK, et al. Patients choose certainty over burden in bladder cancer surveillance. World J Urol [Internet]. 2019 Dec 1 [cited 2021 Jan 3];37(12):2747–53. Available from: https://pubmed.ncbi.nlm.nih.gov/30903352/.

  38. Brown FM. Urine cytology: is it still the gold standard for screening? Urol Clin North Am [Internet]. 2000 [cited 2021 Jan 3];27(1):25–37. Available from: https://pubmed.ncbi.nlm.nih.gov/10696242/.

  39. Giordano A, Soria F. Role and efficacy of current biomarkers in bladder cancer. AME Med J [Internet]. 2020 Mar 25 [cited 2021 Jan 3];5(0):6–6. Available from: http://amj.amegroups.com/article/view/5394/html

  40. Lotan Y, Osullivan P, Raman JD, Shariat SF, Kavalieris L, Frampton C, et al. Clinical comparison of noninvasive urine tests for ruling out recurrent urothelial carcinoma. Urol Oncol Semin Orig Investig. 2017;35(8):531.e15–22.

    Google Scholar 

  41. Wright JL, Hotaling J, Porter MP. Predictors of upper tract urothelial cell carcinoma after primary bladder cancer: a population based analysis. JURO [Internet] 2009 [cited 2021 Jan 3];181:1035–9. Available from: www.jurology.com.

  42. Göǧüş Ç, Baltaci S, Şahinli S, Türkölmez K, Bedük Y, Göüs O. Value of selective upper tract cytology for recognition of upper tract tumors after treatment of superficial bladder cancer. Int J Urol [Internet]. 2003 May 1 [cited 2021 Jan 3];10(5):243–6. Available from: https://pubmed.ncbi.nlm.nih.gov/12694462/

  43. Donin NM, Lenis AT, Holden S, Drakaki A, Pantuck A, Belldegrun A, et al. Immunotherapy for the treatment of urothelial carcinoma. J Urol [Internet]. 2017 Jan 1 [cited 2021 Jan 10];197(1):14–22. Available from: http://www.jurology.com/doi/10.1016/j.juro.2016.02.3005.

  44. Old LJ, Clarke DA, Benacerraf B. Effect of bacillus calmette-guérin infection on transplanted tumours in the mouse. Nature [Internet]. 1959 [cited 2021 Jan 10];184(4682):291–2. Available from: https://www.nature.com/articles/184291a0.

  45. Morales A, Eidinger D, Bruce AW. Intracavitary bacillus Calmette Guerin in the treatment of superficial bladder tumors. J Urol. 1976;116(2):180–2.

    Article  CAS  Google Scholar 

  46. Babjuk M, Burger M, Compérat EM, Gontero P, Mostafid AH, Palou J, et al. European Association of Urology guidelines on non-muscle-invasive bladder cancer (TaT1 and carcinoma in situ) – 2019 update. Eur Urol. 2019;76:369.

    Article  Google Scholar 

  47. Rouprêt M, Neuzillet Y, Masson-Lecomte A, Colin P, Compérat E, Dubosq F, et al. CCAFU french national guidelines 2016-2018 on bladder cancer. Prog Urol. 2016;1(27):S67–91.

    Article  Google Scholar 

  48. Gandhi NM, Morales A, Lamm DL. Bacillus Calmette-Guérin immunotherapy for genitourinary cancer [Internet]. Vol. 112, BJU International. BJU Int; 2013 [cited 2021 Jan 10]. p. 288–97. Available from: https://pubmed.ncbi.nlm.nih.gov/23517232/.

  49. Redelman-Sidi G, Glickman MS, Bochner BH. The mechanism of action of BCG therapy for bladder cancer-A current perspective [Internet]. Vol. 11, Nature Reviews Urology. Nature Publishing Group; 2014 [cited 2021 Jan 10]. p. 153–62. Available from: https://pubmed.ncbi.nlm.nih.gov/24492433/.

  50. Lamm DL, Van der Meijden APM, Morales A, Brosman SA, Catalona WJ, Herr HW, et al. Incidence and treatment of complications of bacillus Calmette-Guerin intravesical therapy in superficial bladder cancer. J Urol [Internet]. 1992; [cited 2021 Jan 10];147(3 I):596–600. Available from: https://pubmed.ncbi.nlm.nih.gov/1538436/

  51. Lamm DL, Dehaven JI, Riggs DR. Keyhole limpet hemocyanin immunotherapy of bladder cancer: Laboratory and clinical studies. In: European Urology [Internet]. S. Karger AG; 2000 [cited 2021 Jan 16]. p. 41–4. Available from: https://pubmed.ncbi.nlm.nih.gov/10828686/.

  52. Lamm DL, Blumenstein BA, Crissman JD, Montie JE, Gottesman JE, Lowe BA, et al. Maintenance bacillus Calmette-Guerin immunotherapy for recurrent ta, T1 and carcinoma in situ transitional cell carcinoma of the bladder: a randomized southwest oncology group study. J Urol. 2000;163(4):1124–9.

    Article  CAS  Google Scholar 

  53. Lamm DL. Efficacy and safety of bacille Calmette-Guérin immunotherapy in superficial bladder cancer. In: Clinical infectious diseases [Internet]. Clin Infect Dis; 2000 [cited 2021 Jan 10]. Available from: https://pubmed.ncbi.nlm.nih.gov/11010830/.

  54. Rischmann P, Desgrandchamps F, Malavaud B, Chopin DK. BCG intravesical instillations: recommendations for side-effects management. Eur Urol [Internet]. 2000 [cited 2021 Jan 16];37(Suppl. 1):33–6. Available from: https://www.karger.com/Article/FullText/52381.

  55. Sylvester RJ, Brausi MA, Kirkels WJ, Hoeltl W, Calais Da Silva F, Powell PH, et al. Long-term efficacy results of EORTC Genito-urinary group randomized phase 3 study 30911 comparing Intravesical instillations of Epirubicin, bacillus Calmette-Guérin, and bacillus Calmette-Guérin plus isoniazid in patients with intermediate- and high-risk stage ta T1 urothelial carcinoma of the bladder. Eur Urol. 2010;57(5):766–73.

    Article  Google Scholar 

  56. Fernandez-Gomez J, Solsona E, Unda M, Martinez-Piñeiro L, Gonzalez M, Hernandez R, et al. Prognostic factors in patients with non-muscle-invasive bladder cancer treated with bacillus Calmette-Guérin: multivariate analysis of data from four randomized CUETO trials. Eur Urol. 2008;53(5):992–1002.

    Article  Google Scholar 

  57. Fda, Cder, Mccrayk. BCG-unresponsive nonmuscle invasive bladder cancer: developing drugs and biologics for treatment guidance for industry [Internet]. 2018 [cited 2021 Jan 10]. Available from: https://www.fda.gov/Drugs/GuidanceComplianceRegulatoryInformation/Guidances/default.htmand/ or https://www.fda.gov/BiologicsBloodVaccines/GuidanceComplianceRegulatoryInformation/Guidances/default.htm.

  58. Novara G, Catto JWF, Wilson T, Annerstedt M, Chan K, Murphy DG, et al. Systematic review and cumulative analysis of perioperative outcomes and complications after robot-assisted radical cystectomy. Eur Urol. 2015;67:376–401.

    Article  Google Scholar 

  59. Porter MP, Penson DF. Health related quality of life after radical cystectomy and urinary diversion for bladder cancer: a systematic review and critical analysis of the literature. J Urol [Internet] 2005 [cited 2021 Jan 10]; Available from: https://www.auajournals.org/doi/abs/10.1097/01.ju.0000149080.82697.65.

  60. Abrams PH, Choa RG, CGC G, Ashken MH, Green NA. A controlled trial of single dose lntravesical adriamycin in superficial bladder Tumours. Br J Urol. 1981;53:585.

    Article  CAS  Google Scholar 

  61. Pan JS, Slocum HK, Rustum YM, Greco WR, Gaeta JF, Huben RP. Inhibition of implantation of murine bladder tumor by thiotepa in cauterized bladder. J Urol. 1989;142:1589.

    Article  CAS  Google Scholar 

  62. Brocks CP, Büttner H, Böhle A. Inhibition of tumor implantation by intravesical gemcitabine in a murine model of superficial bladder cancer. J Urol. 2005;174:1115–18.

    Google Scholar 

  63. Pode D, Alon Y, Horowitz AT, Vlodavsky I, Biran S. The mechanism of human bladder tumor implantation in an in vitro model. J Urol. 1986;136(2):482–86.

    Google Scholar 

  64. Flaig TW, Spiess PE, Agarwal N, Bangs R, Boorjian SA, Buyyounouski MK, et al. NCCN guidelines insights: bladder cancer, Version 52018, J Natl Compr Cancer Netw. 2018.

    Google Scholar 

  65. Messing EM, Tangen CM, Lerner SP, Sahasrabudhe DM, Koppie TM, Wood DP, et al. Effect of intravesical instillation of gemcitabine vs saline immediately following resection of suspected low-grade non-muscle-invasive bladder cancer on tumor recurrence SWOG S0337 randomized clinical trial. JAMA J Am Med Assoc. 2018;319(18):1880–88.

    Google Scholar 

  66. Kang M, Jeong CW, Kwak C, Kim HH, Ku JH. Single, immediate postoperative instillation of chemotherapy in non-muscle invasive bladder cancer: a systematic review and network meta-analysis of randomized clinical trials using different drugs. Oncotarget. 2016;7(29):45479–88.

    Google Scholar 

  67. Naya Y, Mikami K, Takaha N, Inoue Y, Fujihara A, Kanazawa M, et al. Randomized study of intravesical pirarubicin chemotherapy with low and intermediate-risk nonmuscle-invasive bladder cancer in Japan: comparison of a single immediate postoperative intravesical instillation with short-term adjuvant intravesical instillation. Med (United States). 2018;97(42):12740.

    Google Scholar 

  68. Sylvester RJ, Oosterlinck W, Holmang S, Sydes MR, Birtle A, Gudjonsson S, et al. Systematic review and individual patient data meta-analysis of randomized trials comparing a single immediate instillation of chemotherapy after transurethral resection with transurethral resection alone in patients with stage pTa-pT1 urothelial carcinoma. Eur Urol. 2016;69(2):231–44.

    Google Scholar 

  69. Perlis N, Zlotta AR, Beyene J, Finelli A, Fleshner NE, Kulkarni GS. Immediate post- transurethral resection of bladder tumor intravesical chemotherapy prevents non-muscle- invasive bladder cancer recurrences: an updated meta-analysis on 2548 patients and quality-of-evidence review. Eur Urol. 2013;64(3):421–30.

    Google Scholar 

  70. Oddens JR, Van Der Meijden APM, Sylvester R. One immediate postoperative instillation of chemotherapy in low risk ta, T1 bladder cancer patients. Is it always safe? Eur Urol. 2004;46(3):336–38.

    Google Scholar 

  71. Tolley DA, Parmar MKB, Grigor KM, Lallemand G, Beynon LL, Fellows SJ, et al. The effect of intravesical mitomycin C on recurrence of newly diagnosed superficial bladder cancer: a further report with 7 years of followup. J Urol. 1996;155(4):1233–38.

    Google Scholar 

  72. Liu B, Wang Z, Chen B, Yu J, Zhang P, Ding Q, et al. Randomized study of single instillation of epirubicin for superficial bladder carcinoma: long-term clinical outcomes. Cancer Investig. 2006;24(2):60–63.

    Google Scholar 

  73. Türkeri L, Tanidir Y, Çal Ç, Özen H, Şahin H. Comparison of the efficacy of single or double intravesical epirubicin instillation in the early postoperative period to prevent recurrences in non-muscle-invasive urothelial carcinoma of the bladder: prospective, randomized multicenter study. Urol Int. 2010;85(3):261–65.

    Google Scholar 

  74. Sylvester RJ, Oosterlinck W, Van Der Meijden APM. A single immediate postoperative instillation of chemotherapy decreases the risk of recurrence in patients with stage ta T1 bladder cancer: a meta-analysis of published results of randomized clinical trials. J Urol. 2004;30(4):353–54.

    Google Scholar 

  75. Bouffioux C, Kurth KH, Bono A, Oosterlinck W, Kruger CB, De Pauw M, et al. Original articles: bladder cancer: intravesical adjuvant chemotherapy for superficial transitional cell bladder carcinoma: results of 2 European Organization for Research and Treatment of cancer randomized trials with mitomycin C and doxorubicin comparing. J Urol. 1995;153(3 pt 2):934–41.

    Google Scholar 

  76. Chou R, Buckley D, Fu R, Gore JL, Gustafson K, Griffin JC, et al. Emerging approaches to diagnosis and treatment of non–muscle-invasive bladder cancer. Comp Eff Rev. 2015;15(16).

    Google Scholar 

  77. Böhle A, Bock PR. Intravesical bacille Calmette-Guérin versus mitomycin C in superficial bladder cancer: formal meta-analysis of comparative studies on tumor progression. Urology. 2004;173(3):730–31.

    Google Scholar 

  78. Chou R, Selph S, Buckley DI, Fu R, Griffin JC, Grusing S, et al. Intravesical therapy for the treatment of nonmuscle invasive bladder cancer: a systematic review and meta-analysis. J Urol. 2017;197(5):1189–199.

    Google Scholar 

  79. Malmström PU, Sylvester RJ, Crawford DE, Friedrich M, Krege S, Rintala E, et al. An individual patient data meta-analysis of the long-term outcome of randomised studies comparing intravesical mitomycin C versus bacillus Calmette-Guérin for non-muscle-invasive bladder cancer. Eur Urol. 2009;56(2):247–56.

    Google Scholar 

  80. Zargar H, Aning J, Ischia J, So A, Black P. Optimizing intravesical mitomycin C therapy in non-muscle-invasive bladder cancer. Nat Rev Urol. 2014;11(4):220–30.

    Google Scholar 

  81. Au JLS, Badalament RA, Wientjes MG, Young DC, Warner JA, Venema PL, et al. Methods to improve efficacy of intravesical mitomycin C: results of a randomized phase III trial. J Natl Cancer Inst. 2001;93(8):597–604.

    Google Scholar 

  82. Guillaume Wientjes M, Badalament RA, Au JLS. Use of pharmacologic data and computer simulations to design an efficacy trial of intravesical mitomycin C therapy for superficial bladder cancer. Cancer Chemother Pharmacol. 1993;32:255–62.

    Google Scholar 

  83. Au JL-S, Badalament RA, Wientjes MG, Young DC, Warner JA, Venema PL, et al. Methods to improve efficacy of Intravesical Mitomycin C: results of a randomized phase III trial. JNCI J Natl Cancer Inst [Internet] 2001 Apr 18 [cited 2021 Jan 31];93(8):597–604. Available from: https://academic.oup.com/jnci/article-lookup/doi/10.1093/jnci/93.8.597.

  84. Friedrich MG, Pichlmeier U, Schwaibold H, Conrad S, Huland H. Long-term Intravesical adjuvant chemotherapy further reduces recurrence rate compared with short-term Intravesical chemotherapy and short-term therapy with bacillus Calmette-Guérin (BCG) in patients with non-muscle-invasive bladder carcinoma. Eur Urol. 2007;52(4):1123–29.

    Google Scholar 

  85. Sylvester RJ, Oosterlinck W, Witjes JA. The schedule and duration of intravesical chemotherapy in patients with non-muscle-invasive bladder cancer: a systematic review of the published results of randomized clinical trials. Eur Urol. 2008;53(4):709–19.

    Google Scholar 

  86. Onrust SV, Wiseman LR, Goa KL. Epirubicin. A review of its intravesical use in superficial bladder cancer. Drugs and Aging. 1999;15(4):307–33.

    Google Scholar 

  87. Van Der Meijden APM, Brausi M, Zambon V, Kirkels W, De Balincourt C, Sylvester R, et al. Intravesical instillation of epirubicin, bacillus Calmette-Guerin and bacillus Calmette-Guerin plus isoniazid for intermediate and high risk TA, T1 papillary carcinoma of the bladder: a European Organization for Research and Treatment of cancer Genito-Uri. J Urol. 2001;166(2):476–81.

    Google Scholar 

  88. Hendricksen K, Kiemeney LA, Caris C, Janzing R, Witjes W, Witjes JA. Comparison of three schedules of adjuvant intravesical epirubicin in patients with non-muscle invasive bladder cancer Eur Urol Suppl. 2008;53(5):984–91.

    Google Scholar 

  89. Elsawy AA, El-Assmy AM, Bazeed MA, Ali-El-Dein B. The value of immediate postoperative intravesical epirubicin instillation as an adjunct to standard adjuvant treatment in intermediate and high-risk non–muscle-invasive bladder cancer: a preliminary results of randomized controlled trial. Urol Oncol Semin Orig Investig. 2019;37(3):179.

    Google Scholar 

  90. Sylvester RJ, Brausi MA, Kirkels WJ, Hoeltl W, Calais Da Silva F, Powell PH, et al. Long- term efficacy results of EORTC Genito-urinary group randomized phase 3 study 30911 comparing Intravesical instillations of Epirubicin, bacillus Calmette-Guérin, and bacillus Calmette-Guérin plus isoniazid in patients with intermediate- and high-risk . Eur Urol. 2010;57(5):766–73.

    Google Scholar 

  91. Dinney CPN, Greenberg RE, Steinberg GD. Intravesical valrubicin in patients with bladder carcinoma in situ and contraindication to or failure after bacillus Calmette-Guérin. Urol Oncol Semin Orig Investig. 2013;31(8):1635–42.

    Google Scholar 

  92. Witjes JA, Van Der Heijden AG, Vriesema JLJ, Peters GJ, Laan A, Schalken JA. Intravesical gemcitabine: a phase 1 and pharmacokinetic study. Eur Urol. 2004;45(2):182–6.

    Google Scholar 

  93. Di Lorenzo G, Perdonà S, Damiano R, Faiella A, Cantiello F, Pignata S, et al. Gemcitabine versus bacille Calmette-Guérin after initial bacille Calmette-Guérin failure in non-muscle- invasive bladder cancer: a multicenter prospective randomized trial. Cancer. 2010;116(8):1893–1900.

    Google Scholar 

  94. Addeo R, Caraglia M, Bellini S, Abbruzzese A, Vincenzi B, Montella L, et al. Randomized phase III trial on gemcitabine versus mytomicin in recurrent superficial bladder cancer: evaluation of efficacy and tolerance. J Clin Oncol. 2010;28(4):543–8.

    Google Scholar 

  95. Skinner EC, Goldman B, Sakr WA, Petrylak DP, Lenz HJ, Lee CT, et al. SWOG S0353: phase II trial of intravesical gemcitabine in patients with nonmuscle invasive bladder cancer and recurrence after 2 prior courses of intravesical bacillus calmette-guérin. J Urol. 2013;190(4):1200–04.

    Google Scholar 

  96. Jones G, Cleves A, Wilt TJ, Mason M, Kynaston HG, Shelley M. Intravesical gemcitabine for non-muscle invasive bladder cancer. Cochrane Database Syst Rev. 2012 Jan 18.

    Google Scholar 

  97. Verweij J, Clavel M, Chevalier B. Paclitaxel (Taxol™) and docetaxel (Taxotere™): not simply two of a kind. Ann Oncol. 1994;5(6):495–505.

    Google Scholar 

  98. Rangel C, Niell H, Miller A, Cox C. Taxol and taxotere in bladder cancer: in vitro activity and urine stability. Cancer Chemother Pharmacol. 1994;33(6):460–64.

    Google Scholar 

  99. Laudano MA, Barlow LJ, Murphy AM, Petrylak DP, Desai M, Benson MC, et al. Long-term clinical outcomes of a phase I trial of Intravesical docetaxel in the Management of non- muscle- invasive bladder cancer refractory to standard intravesical therapy. Urology. 2010;75(1):134–7.

    Google Scholar 

  100. Barlow LJ, McKiernan JM, Benson MC. Long-term survival outcomes with intravesical docetaxel for recurrent nonmuscle invasive bladder cancer after previous bacillus Calmette- Guérin therapy. J Urol. 2013;189(3):834–39.

    Google Scholar 

  101. Barlow L, McKiernan J, Sawczuk I, Benson M. A single-institution experience with induction and maintenance intravesical docetaxel in the management of non-muscle-invasive bladder cancer refractory to bacille Calmette-Guérin therapy. BJU Int. 2009;104(8):1098–102.

    Google Scholar 

  102. Sekine H, Fukui I, Yamada T, Ohwada F, Yokokawa M, Ohshima H. Intravesical mitomycin C and doxorubicin sequential therapy for carcinoma in situ of the bladder: a longer followup result. J Urol. 1994;151(1):27–30.

    Google Scholar 

  103. Marttila T, Järvinen R, Liukkonen T, Rintala E, Boström P, Seppänen M, et al. Intravesical bacillus Calmette-Guérin versus combination of Epirubicin and interferon-α2a in reducing recurrence of non–muscle-invasive bladder carcinoma: FinnBladder-6 study. Eur Urol. 2016:70(2):341–47.

    Google Scholar 

  104. Lightfoot AJ, Breyer BN, Rosevear HM, Erickson BA, Konety BR, O’Donnell MA. Multi- institutional analysis of sequential intravesical gemcitabine and mitomycin C chemotherapy for non-muscle invasive bladder cancer. Urol Oncol Semin Orig Investig. 2014;32(1) 35.e15–19.

    Google Scholar 

  105. Steinberg RL, Thomas LJ, O’Donnell MA, Nepple KG. Sequential intravesical gemcitabine and docetaxel for the salvage treatment of non-muscle invasive bladder cancer. Bl Cancer. 2015;1(1):65–72.

    Google Scholar 

  106. Decastro GJ, Sui W, Pak JS, Lee SM, Holder D, Kates MM, et al. A phase i trial of intravesical cabazitaxel, gemcitabine and cisplatin for the treatment of nonmuscle invasive bacillus calmette-guérin unresponsive or recurrent/relapsing urothelial carcinoma of the bladder. J Urol. 2020;204(2):247–53.

    Google Scholar 

  107. Powles T, Eder JP, Fine GD, Braiteh FS, Loriot Y, Cruz C, et al. MPDL3280A (anti-PD-L1) treatment leads to clinical activity in metastatic bladder cancer. Nature [Internet]. 2014 Nov 27 [cited 2021 Jan 10];515(7528):558–62. Available from: https://www.nature.com/articles/nature13904.

  108. Balar AV, Kamat AM, Kulkarni GS, Uchio EM, Boormans JL, Bajorin DF, et al. Pembrolizumab (pembro) for the treatment of patients with bacillus Calmette-Guérin (BCG) unresponsive, high-risk (HR) non–muscle-invasive bladder cancer (NMIBC): over two years follow-up of KEYNOTE-057. J Clin Oncol. 2020;38(15_suppl):5041.

    Article  Google Scholar 

  109. Black PC, Tangen C, Singh P, McConkey DJ, Lucia S, Lowrance WT, et al. Phase II trial of atezolizumab in BCG-unresponsive non-muscle invasive bladder cancer: SWOG S1605 (NCT #02844816). J Clin Oncol. 2020;38(15_suppl):5022.

    Article  Google Scholar 

  110. Yamashita M, Rosser CJ, Zhou JH, Zhang XQ, Connor RJ, Engler H, et al. Syn3 provides high levels of intravesical adenoviral-mediated gene transfer for gene therapy of genetically altered urothelium and superficial bladder cancer. Cancer Gene Ther [Internet]. 2002 [cited 2021 Jan 10];9(8):687–91. Available from: https://pubmed.ncbi.nlm.nih.gov/12136430/.

  111. Benedict WF, Tao Z, Kim CS, Zhang X, Zhou JH, Adam L, et al. Intravesical Ad-IFNα causes marked regression of human bladder cancer growing orthotopically in nude mice and overcomes resistance to IFN-α protein. Mol Ther [Internet]. 2004 Sep [cited 2021 Jan 10];10(3):525–32. Available from: https://pubmed.ncbi.nlm.nih.gov/15336652/.

  112. Tao Z, Connor RJ, Ashoori F, Dinney CPN, Munsell M, Philopena JA, et al. Efficacy of a single intravesical treatment with Ad-IFN/Syn 3 is dependent on dose and urine IFN concentration obtained: Implications for clinical investigation. Cancer Gene Ther [Internet]. 2006 Feb [cited 2021 Jan 10];13(2):125–30. Available from: https://pubmed.ncbi.nlm.nih.gov/16082384/.

  113. Shore ND, Boorjian SA, Canter DJ, Ogan K, Karsh LI, Downs TM, et al. Intravesical rAd–IFNa/Syn3 for patients with high-grade, bacillus calmette-guerin–refractory or relapsed non–muscle-invasive bladder cancer: A phase II randomized study. J Clin Oncol [Internet]. 2017 Oct 20 [cited 2021 Jan 10];35(30):3410–6. Available from: https://ascopubs.org/doi/10.1200/JCO.2017.72.3064.

  114. Boorjian SA, Alemozaffar M, Konety BR, Shore ND, Gomella LG, Kamat AM, et al. Intravesical nadofaragene firadenovec gene therapy for BCG-unresponsive non-muscle-invasive bladder cancer: a single-arm, open-label, repeat-dose clinical trial. Lancet Oncol [Internet]. 2020 Nov 1 [cited 2021 Jan 10];22(1):107–17. Available from: www.thelancet.com/oncology.

  115. Rosenberg SA. IL-2: The First Effective Immunotherapy for Human Cancer. J Immunol [Internet]. 2014 Jun 15 [cited 2021 Jan 10];192(12):5451–8. Available from: https://pubmed.ncbi.nlm.nih.gov/24907378/.

  116. Lee S, Margolin K. Cytokines in Cancer Immunotherapy. Cancers (Basel) [Internet]. 2011 Oct 13 [cited 2021 Jan 10];3(4):3856–93. Available from: http://www.mdpi.com/2072-6694/3/4/3856.

  117. Sonpavde G, Rosser CJ, Pan C, Parikh RA, Nix J, Gingrich JR, et al. Phase I trial of ALT-801, a first-in-class T-cell receptor (TCR)-interleukin (IL)-2 fusion molecule, plus gemcitabine (G) for bacillus Calmette Guerin (BCG)-resistant non-muscle-invasive bladder cancer (NMIBC). J Clin Oncol. 2015;33(15_suppl):e15509.

    Article  Google Scholar 

  118. Chamie K, Lee JH, Rock A, Rhode PR, Soon-Shiong P. Preliminary phase 2 clinical results of IL-15RαFc superagonist N-803 with BCG in BCG-unresponsive non-muscle invasive bladder cancer (NMIBC) patients. J Clin Oncol. 2019;37(15_suppl):4561.

    Article  Google Scholar 

  119. Rosser CJ, Nix J, Ferguson L, Hernandez L, Wong HC. Phase Ib trial of ALT-803, an IL-15 superagonist, plus BCG for the treatment of BCG-naïve patients with non-muscle-invasive bladder cancer. J Clin Oncol. 2018;36(6_suppl):510.

    Article  Google Scholar 

  120. Vicinium Treatment for Subjects With Non-muscle Invasive Bladder Cancer Previously Treated With BCG – Full Text View – ClinicalTrials.gov [Internet]. [cited 2021 Jan 10]. Available from: https://clinicaltrials.gov/ct2/show/NCT02449239.

  121. Kowalski M, Guindon J, Brazas L, Moore C, Entwistle J, Cizeau J, et al. A phase II study of oportuzumab monatox: An immunotoxin therapy for patients with noninvasive urothelial carcinoma in situ previously treated with bacillus Calmette-Guérin. J Urol [Internet]. 2012 Nov [cited 2021 Jan 10];188(5):1712–8. Available from: https://pubmed.ncbi.nlm.nih.gov/22998907/

  122. Rentsch CA, Bosshard P, Mayor G, Rieken M, Püschel H, Wirth G, et al. Results of the phase I open label clinical trial SAKK 06/14 assessing safety of intravesical instillation of VPM1002BC, a recombinant mycobacterium bacillus Calmette Guérin (BCG), in patients with non-muscle invasive bladder cancer and previous failure of conventional BCG therapy. Oncoimmunology [Internet]. 2020;Jan 1 [cited 2021 Jan 10];9(1). Available from: /pmc/articles/PMC7185202/?report=abstract

    Google Scholar 

  123. IBCN 2020: Efficacy, Safety and Tolerability of the rBCG VPM1002BC in Patients with High-Grade NMIBC Recurrence after BCG Induction with or without BCG Maintenance Therapy – SAKK 06/14 [Internet]. [cited 2021 Jan 10]. Available from: https://www.urotoday.com/conference-highlights/ibcn-2020/125268-ibcn-2020-results-of-a-phase-i-ii-single-arm-clinical-trial-assessing-efficacy-safety-and-tolerability-of-the-recombinant-bacillus-calmette-guerin-vpm1002bc-in-patients-with-non-muscle-invasive-bladder-cancer-recurrence-after-bcg-induction-with-or-without-bcg-maintenance-therapy-sakk-06-14.html.

  124. Paroni R, Salonia A, Lev A, Da Pozzo LF, Cighetti G, Montorsi F, et al. Effect of local hyperthermia of the bladder on mitomycin C pharmacokinetics during intravesical chemotherapy for the treatment of superficial transitional cell carcinoma. Br J Clin Pharmacol Suppl. 2001.

    Google Scholar 

  125. Colombo R, Lev A, Da Pozzo LF, Freschi M, Gallus G, Rigatti P. Original articles: bladder cancer: a new approach using local combined microwave hyperthermia and chemotherapy in superficial transitional bladder carcinoma treatment. J Urol. 1995.

    Google Scholar 

  126. Colombo R, Da Pozzo LF, Salonia A, Rigatti P, Leib Z, Baniel J, et al. Multicentric study comparing intravesical chemotherapy alone and with local microwave hyperthermia for prophylaxis of recurrence of superficial transitional cell carcinoma. J Clin Oncol. 2003.

    Google Scholar 

  127. Colombo R, Salonia A, Leib Z, Pavone-Macaluso M, Engelstein D. Long-term outcomes of a randomized controlled trial comparing thermochemotherapy with mitomycin-C alone as adjuvant treatment for non-muscle-invasive bladder cancer (NMIBC). BJU Int. 2011;107(6):912–18.

    Google Scholar 

  128. Alfred Witjes J, Hendricksen K, Gofrit O, Risi O, Nativ O. Intravesical hyperthermia and mitomycin-C for carcinoma in situ of the urinary bladder: experience of the European Synergo® working party. World J Urol. 2009;27(3):319–24.

    Google Scholar 

  129. Van Der Heijden AG, Kiemeney LA, Gofrit ON, Nativ O, Sidi A, Leib Z, et al. Preliminary European results of local microwave hyperthermia and chemotherapy treatment in intermediate or high risk superficial transitional cell carcinoma of the bladder. Eur Urol. 2004;46(1):65–71.

    Google Scholar 

  130. Di Stasi SM, Giannantoni A, Massoud R, Dolci S, Navarra P, Vespasiani G, et al. Electromotive versus passive diffusion of mitomycin C into human bladder wall: concentration-depth profiles studies. Cancer Res. 1999;59(19):4912–18.

    Google Scholar 

  131. Colombo R, Brausi M, Da Pozzo LF, Salonia A, Montorsi F, Scattoni V, et al. Thermo-chemotherapy and electromotive drug administration of mitomycin C in superficial bladder cancer eradication: a pilot study on marker lesion. Eur Urol. 2001;39(1):95–100.

    Google Scholar 

  132. Di Stasi SM, Giannantoni A, Stephen RL, Capelli G, Navarra P, Massoud R, et al. Intravesical electromotive mitomycin C versus passive transport mitomycin C for high risk superficial bladder cancer: a prospective randomized study. J Urol. 2003;170(3):777–82.

    Google Scholar 

  133. Di Stasi SM, Giannantoni A, Giurioli A, Valenti M, Zampa G, Storti L, et al. Sequential BCG and electromotive mitomycin versus BCG alone for high-risk superficial bladder cancer: a randomised controlled trial. Lancet Oncol. 2006;7(1):43–51.

    Google Scholar 

  134. Gan C, Amery S, Chatterton K, Khan MS, Thomas K, O’Brien T. Sequential bacillus Calmette-Guérin/electromotive drug administration of mitomycin C as the standard intravesical regimen in high risk nonmuscle invasive bladder cancer: 2-year outcomes. J Urol. 2016;195(6):1697–1703.

    Google Scholar 

  135. Di Stasi SM, Valenti M, Verri C, Liberati E, Giurioli A, Leprini G, et al. Electromotive instillation of mitomycin immediately before transurethral resection for patients with primary urothelial non-muscle invasive bladder cancer: a randomised controlled trial. Lancet Oncol. 2011;12(9):871–9.

    Google Scholar 

  136. Railkar R, Agarwal PK. Photodynamic therapy in the treatment of bladder cancer: past challenges and current innovations. Eur Uro Focus. 2018;4(4):509–11.

    Google Scholar 

  137. Berg K, Selbo PK, Weyergang A, Dietze A, Prasmickaite L, Bonsted A, et al. Porphyrin-related photosensitizers for cancer imaging and therapeutic applications. J Microsc. 2005;218(2):133–47.

    Google Scholar 

  138. Bachor R, Reich E, Rück A, Hautmann R. Aminolevulinic acid for photodynamic therapy of bladder carcinoma cells. Urol Res. 1996;24(5):285–9.

    Google Scholar 

  139. Waidelich R, Stepp H, Baumgartner R, Weninger E, Hofstetter A, Kriegmair M. Clinical experience with 5-aminolevulinic acid and photodynamic therapy for refractory superficial bladder cancer. J Urol. 2001;165(6 Pt 1):1904–07.

    Google Scholar 

  140. Berger AP, Steiner H, Stenzl A, Akkad T, Bartsch G, Holtl L. Photodynamic therapy with intravesical instillation of 5-aminolevulinic acid for patients with recurrent superficial bladder cancer: a single-center study. Urology. 2003;61:338.

    Article  Google Scholar 

  141. Filonenko EV, Kaprin AD, Alekseev BYA, Apolikhin OI, Slovokhodov EK, Ivanova-Radkevich VI, et al. 5-Aminolevulinic acid in intraoperative photodynamic therapy of bladder cancer (results of multicenter trial). Photodiagn Photodyn Ther. 2016;16:106.

    Article  CAS  Google Scholar 

  142. Lee JY, Diaz RR, Cho KS, Lim MS, Chung JS, Kim WT, et al. Efficacy and safety of photodynamic therapy for recurrent, high grade nonmuscle invasive bladder cancer refractory or intolerant to bacille calmette-Guérin immunotherapy. J Urol. 2013;190:1192.

    Article  Google Scholar 

  143. Bianco FJ, Justa D, Grignon DJ, Sakr WA, Pontes JE, Wood DP. Management of clinical T1 bladder transitional cell carcinoma by radical cystectomy. Urol Oncol Semin Orig Investig [Internet]. 2004 Jul [cited 2021 Jan 4];22(4):290–4. Available from: https://pubmed.ncbi.nlm.nih.gov/15283885/.

  144. Stein JP. Indications for early cystectomy [Internet]. Vol. 62, Urology. Elsevier Inc.; 2003 [cited 2021 Jan 4]. p. 591–5. Available from: http://www.goldjournal.net/article/S0090429503005843/fulltext.

  145. Mohamed NE, Shah QN, Kata HE, Sfakianos J, Given B. Dealing with the unthinkable: bladder and colorectal cancer patients’ and informal caregivers’ unmet needs and challenges in life after ostomies. Semin Oncol Nurs [Internet] 2021 Jan 7 [cited 2021 Jan 10];151111. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0749208120301261.

  146. Stein JP, Lieskovsky G, Cote R, Groshen S, Feng AC, Boyd S, et al. Radical cystectomy in the treatment of invasive bladder cancer: Long-term results in 1,054 patients. J Clin Oncol [Internet]. 2001 Feb 1 [cited 2021 Jan 10];19(3):666–75. Available from: https://pubmed.ncbi.nlm.nih.gov/11157016/.

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to John Sfakianos .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Eilender, B.M., Katims, A.B., Pfail, J.L., Sfakianos, J. (2022). Evolving Treatment in Non-muscle-Invasive Bladder Cancer. In: Stratton, K.L., Morgans, A.K. (eds) Urologic Oncology. Springer, Cham. https://doi.org/10.1007/978-3-030-89891-5_16

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-89891-5_16

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-89890-8

  • Online ISBN: 978-3-030-89891-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics